NPI | 1922255967 |
---|---|
Entity Type | Organization |
Authorized Contact | JOHN DALE CARLSON President 850-682-5332 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL ME0051484) |
Enumeration Date | 2008-08-21 |
Last Update Date | 2008-08-21 |